Suicide Contagion

Every time a celebrity commits suicide, we pay attention to Depression and the tragic end outcome if Depression is not treated or does not respond to treatment; at least for a little while.

I have never owned a Kate Spade purse but I liked her. Together with her husband, they created a brand that took whimsy seriously and added color to our world.

Anthony Bourdain lived the life of my dreams; travel, adventure and food. Could there be more?

Neither Kate Spade or Anthony Bourdain allowed their public personas to reflect the extent of their illness. This is understandable in terms of privacy but leaves many people shaking their heads because they can’t understand how celebrities who appear to have everything would choose to die.

Home healthcare patients are confined to their homes. Some have lost one or more spouses and may be separated from family who have moved to pursue careers. They are sick and many are in pain. Their outward presentation is that of a patient population at high risk for depression.

As it turns out, 20 percent of people over 65 are depressed and men in their 80’s have highest rate of suicide of all age groups. Across the board, the rate of suicide is rising as funding for mental health is declining.

As of last week, patients are at an even greater risk for suicide due to the phenomenon of Suicide Contagion which is exactly what it sounds like. Suicides occur in clusters almost appearing to be contagious like a virus. In the four months after the loss of Robin Williams, the overall suicide rate increased by 10 percent. Google searches for suicide related topics increased after Netflix aired ‘13 Reasons Why’. There was a 25 percent increase in the number of calls to the National Suicide Prevention hotline in the two days following Anthony Bourdain’s death.

One reason has been attributed to journalism standards. There are journalistic guidelines for reporting suicides that nobody seems to follow. Near the top of the list is not reporting on the details of suicide. When reporting on a suicide, the WHO also recommends including information on how to get help. Most initial reports of last week’s high profile deaths included this information – usually at the end of an article that might be missed – but as the days progressed, more attention was given to the ‘gossip’ and a few interesting conspiracy theories surrounding these stories.

But we’re not journalists so how does this pertain to nursing. How many of your patients spend most of their waking hours tuned to the television news? Depending on the reporter or news station, some news stories are almost like a tutorial or at best a psychological autopsy that is really none of our business. Most nurses also have social media accounts. Think twice before sharing or reposting a story that has sensational or dramatic headlines.

What should you do for your patients?

Regardless of prior diagnoses or risk factors, encourage your patient to do something other than consume the details of tragic suicides. You might investigate alternative viewing options, suggest some time outdoors, a book or a crossword.

Pay attention to your PHQ2 assessments. I am incredulous when reading about patients who start their day with a round of golf and end it with their chest opened with power tools due to a cardiac event. Three days later they are admitted to home healthcare and report zero days with little interest or pleasure of doing things or feeling down. A positive PHQ2 does not confirm a diagnosis of depression but it gives you a baseline and together with the physician, you can look at medication side effects, ensure the patient is able to sleep and address pain. If the patient doesn’t show improvement in two weeks, there is a strong possibility that he or she won’t participate in their plan of care to the extent that they can which will prolong healing and further treatment may be indicated.

If your patient is pre-loaded with a diagnosis of Depression and is on medication, take it from there. Don’t just assume it has been handled. Teach side effects of meds, encourage socialization, educate the family, etc. Never assume that a med is going to work completely and consistently. After all, diabetic patients aren’t started on metformin and never checked again.

Talk about depression in the same tone that you talk about other diagnoses. Depression is seen by many from former generations as a weakness. Assure your patient that depression is an illness and is not a reflection on their character or inner strength.

Leave written information adjusted for the reading level and visual acuity of your patient about resources they can access if symptoms worsen. Put the information in a place that is obvious to the patient and near the phone.

Depression is not a normal part of aging. You can implement measures to improve your patient’s depression and dramatically improve the quality of their life. With mental health funding dwindling across the nation, we need to up our game.